The Peace Corps’ highest priority is maintaining the good health and safety of every Volunteer and trainee. Medical programs emphasize the preventive, rather than the curative approach to disease.

Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk.

The Peace Corps’ highest priority is maintaining the good health and safety of every Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. As a rule of thumb, good healthcare comes from good health maintenance. The Peace Corps in El Salvador maintains a full-time medical officer who takes care of Volunteers’ primary healthcare needs. Medical services, such as testing and basic treatment, are also available in El Salvador at local, American-standard hospitals. If you become seriously ill, you will be transported to either a medical facility in the region or to the United States.

Major health problems among Peace Corps Volunteers in El Salvador are rare and are often the result of a Volunteer not taking preventive measures to stay healthy. The most common health problems are mostly minor ones that are also found in the United States, such as colds, diarrhea, hemorrhoids, constipation, sinus infections, skin infections, headaches, ear infections, dental problems, minor injuries, sexually transmitted diseases (STDs), adjustment disorders, emotional problems, and alcohol abuse. These problems may be more frequent or compounded by life in El Salvador, because certain environmental factors here raise the risk and/or exacerbate the severity of illness and injuries.

The most common major health concerns in El Salvador are malaria, rabies, tuberculosis, dengue fever, typhoid, intestinal parasites, upper respiratory infections, hepatitis, and HIV/ AIDS. Because malaria is endemic in El Salvador, anti-malarial medication (aralen)is required. You will also be vaccinated against hepatitis A and B, typhoid, rabies, tuberculosis, and diptheria. Many of these health concerns can be easily avoided by using common sense and following basic preventive practices.

The Peace Corps will provide you with all the necessary inoculations, medications, and information you need to stay healthy; however, you must accept responsibility for the appropriate use of the information and medication provided. Upon your arrival in El Salvador, you will receive a medical handbook. At the end of training, you will receive a first-aid kit with supplies to take care of mild illnesses and first-aid needs.

During training, you will have access to basic first aid supplies through the Peace Corps medical officer. However, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require, as we will not order these items during training. Please bring a three-month supply of any prescription drugs you use since they may not be available here and it may take several months for new shipments to arrive.

You will have physical examinations at mid-service and at the end of your service. If you develop a serious medical problem during your service, the medical officer in El Salvador will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in El Salvador, you may be sent out of the country for further evaluation and care.

As Peace Corps Volunteers, you must accept a certain amount of responsibility for your own health. Proper precautions, if taken, will significantly reduce your risk of contracting serious illness and sustaining serious injury. The old adage, “An ounce of prevention …” becomes extremely important in areas where medical diagnostic and treatment facilities are not up to standards of the United States.

It is critical to your health that you promptly report to the medical office or other designated facility for scheduled immunizations, and that you let your medical officer know immediately of significant illness and injuries.

The most important of your responsibilities include:

Adherence to recommended standards for food and water preparation. Many diseases that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning, amebiasis, giardiasis, hepatitis A, dysentery, worms, tapeworms, cholera, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation for El Salvador during pre-service training.

Strict adherence to recommended drug regimen for the prevention of malaria. Malaria is endemic in most areas of the Peace Corps world. For all Volunteers serving in malaria endemic areas, or for those traveling in malaria endemic areas, it is extremely important to fully comply with the recommended drug regimen to prevent malaria. Malaria can be rapidly fatal in people who have no natural immunity to the disease. Peace Corps Volunteers who do not fully comply with the required preventive regimen may be administratively separated. Your medical officer will discuss specific recommendations for the prevention of malaria in your area.

Prompt reporting to the medical office of any possible exposure to rabies. Rabies is present in nearly all Peace Corps countries. Any possible exposure to a rabid animal must be reported immediately to the medical office. Rabies exposure can occur through animal bites, scratches from animals’ teeth, and contact with animal saliva. Your medial officer will take into consideration many factors to decide the appropriate course of therapy necessary to prevent rabies. Rabies, if contracted, is 100 percent fatal. All necessary rabies immunizations will be given by the Peace Corps medical office and only the Peace Corps medical office.

Use of an effective means of birth control. Volunteers are expected to adhere to an effective means of birth control to prevent unwanted pregnancies. Your medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available without charge from the Peace Corps medical office.

Use of condoms to protect against the spread of STDs and AIDS. Volunteers must use condoms in every sexual encounter where bodily fluids may be transferred, or they risk contracting deadly disease. Condoms will be provided by the medical officer.

Abstinence is the only certain choice for prevention of HIV/ AIDS and other STDs. You are taking risks if you choose to be sexually active. To lessen the risk, use a condom every time you have sex. Whether your partner is a host country citizen, a fellow Volunteer, or anyone else, do not assume this person is free of HIV/AIDS or other STDs.

It is important to emphasize that while AIDS in the United States has occurred primarily (though not exclusively) in high-risk groups, in parts of the developing world, the disease affects men and women equally, regardless of sexual preference. AIDS is a sexually transmitted disease and concerns all sexually active individuals, both homosexual and heterosexual. The keys to reducing the risk of exposure to HIV/AIDS are knowledge and prevention. All Volunteers must be aware of the following basic facts:

AIDS is a fatal viral disease that cannot now be cured.

The AIDS virus is spread by sexual intercourse, by contaminated blood, and by contaminated hypodermic needles.

A person can look and feel healthy and still be able to spread the virus that causes AIDS.

An infected woman can give AIDS to her child during pregnancy or during birth.

AIDS has not been shown to be spread by casual contact, such as living in the same house or sharing eating utensils.

AIDS has not been shown to be transmitted by biting insects.

Celibacy or a stable, monogamous relationship with another uninfected person is the safest way to avoid infection. In any case, reducing the number of sexual partners reduces the chances of getting AIDS.

Use of condoms reduces the exchange of body fluids and may reduce the risk of AIDS infection during sexual contact.

Your Peace Corps medical officer will provide you with more specific information in-country and will keep you informed of measures you can take to reduce your risk of exposure, including:

Abstinence from sexual contact, limiting the number of your sexual partners, and avoiding sexual contact with someone who has had many sexual partners.

Consistent and correct use of condoms with every act of intercourse. Protect yourself, and protect your partner.

Avoid any injections not being provided by your Peace Corps medical officer.

Avoid giving or receiving a blood transfusion except under the supervision of the Peace Corps medical officer, or in cases of life-threatening injury or illness.

Avoid sharing toothbrushes and razors (which may be contaminated with blood).

Avoid all practices that result in penetration of skin surfaces (such as acupuncture, ear-piercing, tattooing, blood-brotherhood ceremonies, or other incisions of the skin during traditional ceremonial or healing practices).

Volunteers are expected to adhere to an effective means of birth control to prevent unplanned pregnancies. Your medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available without charge from the medical officer.

Pregnancy is a health condition that is treated in the same manner as other Volunteer health conditions requiring medical attention, but may also have programmatic ramifications. The Peace Corps is responsible for determining the medical risk and the availability of appropriate medical care if the Volunteer remains in-country. Given the circumstances under which Volunteers live and work in Peace Corps countries, it is rare that the Peace Corps medical and programmatic standards for continued service can be met. The majority of Volunteers who become pregnant are medically separated.

Feminine hygiene products are not provided to you by the Peace Corps medical officer in El Salvador. These products can be purchased in El Salvador, but they are expensive. Some Volunteers opt to bring a supply with them to El Salvador.

If there has been any change in your health—physical, mental, or dental—since the time you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.

If your dental exam was done more than a year ago, or if your physical exam is more than two years old, contact the Office of Medical Services to find out whether you need to update your records.

If your dentist or Peace Corps dental consultant has recommended that you undergo dental treatment or repair, you must complete that work and make sure your dentist sends requested confirmation reports or X-rays to the Office of Medical Services.

If you wish to avoid taking duplicate vaccinations, you should contact your physician’s office, obtain a copy of your immunization record, and bring it to your pre-departure orientation. If you have any immunizations prior to Peace Corps service, the Peace Corps cannot reimburse you for the cost. The Peace Corps will provide all the immunizations necessary for your overseas assignment shortly after you arrive in El Salvador. You do not need to begin taking malaria medication prior to departure.

Bring a three-month supply of any prescription or over-thecounter medication you use on a regular basis, including birth control pills. Although the Peace Corps cannot reimburse you for this three-month supply, we will order refills during your service.

While awaiting shipment—which can take several months— you will be dependent on your own medication supply. The Peace Corps will not pay for herbal or non-prescribed medications, such as St. John’s Wort, glucosamine, Selenium, or anti-oxidant supplements.

You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, although it might come in handy if you are questioned in transit about your on-hand three-month supply of prescription drugs.

If you wear eyeglasses, bring two pairs with you: a pair and a spare. If a pair breaks, the Peace Corps will replace it, using the information your doctor in the United States provided on the eyeglasses form during your examination. To reduce the risk of developing a serious infection or other eye disease, we discourage you from using contact lenses during your Peace Corps service. Most Peace Corps countries do not have appropriate water and sanitation to support eye care with the use of contact lenses. The Peace Corps will not supply or replace contact lenses or associated solutions unless their use has been recommended by an ophthalmologist for a specific medical condition and the Peace Corps’ Office of Medical Services has given approval.

If you are eligible for Medicare, over 50 years of age, or have a health condition that may restrict your future participation in healthcare plans, you may wish to consult an insurance specialist about unique coverage needs before your departure.

The Peace Corps will provide all necessary healthcare from the time you leave for your pre-departure orientation until you complete your service. When you finish, you will be entitled to the post-service healthcare benefits as described in the Peace Corps Volunteer Handbook. You may wish to consider keeping an existing health plan in effect during your service if you think age and/or pre-existing conditions might prevent you from re-enrolling in your current plan when you return home.

Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk. Property thefts and burglaries are not uncommon. Incidents of physical and sexual assault do occur, although almost all Volunteers complete their two years of service without serious personal safety problems. In addition, more than 84 percent of Volunteers surveyed in the 2004 Peace Corps Volunteer Survey say they would join the Peace Corps again.

The Peace Corps approaches safety and security as a partnership with you. This Welcome Book contains sections on: Living Conditions and Volunteer Lifestyle; Peace Corps Training; and Your Health Care and Safety. All of these sections include important safety and security information.

The Peace Corps makes every effort to give Volunteers the tools they need to function in the safest and most secure way possible, because working to maximize the safety and security of Volunteers is our highest priority. Not only do we provide you with training and tools to prepare for the unexpected, but we teach you to identify and manage the risks you may encounter.

There are several factors that can heighten a Volunteer’s risk, many of which are within the Volunteer’s control.

Based on information gathered from incident reports worldwide in 2004, the following factors stand out as risk characteristics for assaults. Assaults consist of personal crimes committed against Volunteers, and do not include property crimes (such as vandalism or theft).

Location: Most crimes occurred when Volunteers were in public areas (e.g., street, park, beach, public buildings). Specifically, 43 percent of assaults took place when Volunteers were away from their sites.

Time of day: Assaults usually took place on the weekend during the evening between 5:00 p.m. and 2:00 a.m.— with most assaults occurring around 1:00 a.m.

Absence of others: Assaults ususally occurred when the Volunteer was unaccompanied. In 82 percent of the sexual assaults the Volunteer was unaccompannied and in 55 percent of physical assaults the Volunteer was unaccompanied.

Relationship to assailant: In most assaults, the Volunteer did not know the assailant.

In March 2003, the Peace Corps created the Office of Safety and Security with its mission to “foster improved communication, coordination, oversight, and accountability of all Peace Corps’ safety and security efforts.” The new office is led by an Associate Director for Safety and Security who reports to the Peace Corps Director and includes the following divisions: Volunteer Safety and Overseas Security; Information and Personnel Security; Emergency Preparedness, Plans, Training and Exercise; and Crime Statistics and Analysis.

The major responsibilities of the Volunteer Safety and Overseas Security Division are to coordinate the office’s overseas operations and direct the Peace Corps’ safety and security officers who are located in various regions around the world that have Peace Corps programs. The safety and security officers conduct security assessments; review safety trainings; train trainers and managers; train Volunteer safety wardens, local guards, and staff; develop security incident response procedures; and provide crisis management support.

If a trainee or Volunteer is the victim of a safety incident, Peace Corps staff is prepared to provide support. All Peace Corps posts have procedures in place to respond to incidents of crime committed against Volunteers. The first priority for all posts in the aftermath of an incident is to ensure that the Volunteer is safe and receiving medical treatment as needed. After assuring the safety of the Volunteer, Peace Corps staff provide support by reassessing the Volunteer’s work site and housing arrangements and making any adjustments, as needed. In some cases, the nature of the incident may necessitate a site or housing transfer. Peace Corps staff will also assist Volunteers with preserving their rights to pursue legal sanctions against the perpetrators of the crime. It is very important that Volunteers report incidents as they occur, not only to protect their peer Volunteers, but also to preserve the future right to prosecute. Should Volunteers decide later in the process that they want to proceed with the prosecution of their assailant, this option may no longer exist if the evidence of the event has not been preserved at the time of the incident.

The country-specific data chart below shows the incidence rates and the average number of incidents of the major types of safety incidents reported by Peace Corps Volunteers/ trainees in El Salvador as compared to all other Inter-America and Pacific region programs as a whole, from 2000–2004. It is presented to you in a somewhat technical manner for statistical accuracy.

To fully appreciate the collected data below, an explanation of the graph is provided as follows:

The incidence rate for each type of crime is the number of crime events relative to the Volunteer/trainee population. It is expressed on the chart as a ratio of crime to Volunteer and trainee years (or V/T years, which is a measure of 12 full months of V/T service) to allow for a statistically valid way to compare crime data across countries. An “incident” is a specific offense, per Peace Corps' classification of offenses, and may involve one or more Volunteer/trainee victims. For example, if two Volunteers are robbed at the same time and place, this is classified as one robbery incident.

The chart is separated into eight crime categories. These include vandalism (malicious defacement or damage of property); theft (taking without force or illegal entry); burglary (forcible entry of a residence); robbery (taking something by force); minor physical assault (attacking without a weapon with minor injuries); minor sexual assault (fondling, groping, etc.); aggravated assault (attacking with a weapon, and/or without a weapon when serious injury results); and rape (sexual intercourse without consent).

When anticipating Peace Corps Volunteer service, you should review all of the safety and security information provided to you, including the strategies to reduce risk. Throughout your training and Volunteer service, you will be expected to successfully complete all training competencies in a variety of areas including safety and security. Once in-country, use the tools and information shared with you to remain as safe and secure as possible.

Few Peace Corps Volunteers are victims of violent crimes. The Peace Corps will give you information and training in how to be safe. But, just as in the U.S., crime happens, and Volunteers can become victims. When this happens, the investigative team of the Office of Inspector General (OIG) is charged with helping pursue prosecution of those who perpetrate a violent crime against a Volunteer. If you become a victim of a violent crime, the decision to prosecute or not to prosecute is entirely yours, and one of the tasks of the OIG is to make sure that you are fully informed of your options and help you through the process and procedures involved in going forward with prosecution should you wish to do so. If you decide to prosecute, we are here to assist you in every way we can.

Crimes that occur overseas, of course, are investigated and prosecuted by local authorities in local courts. Our role is to coordinate the investigation and evidence collection with the regional security officers (RSOs) at the U.S. embassy, local police, and local prosecutors and others to ensure that your rights are protected to the fullest extent possible under the laws of the country. OIG investigative staff has extensive experience in criminal investigation, in working sensitively with victims, and as advocates for victims. We also, may, in certain limited circumstances, arrange for the retention of a local lawyer to assist the local public prosecutor in making the case against the individual who perpetrated the violent crime.

If you do become a victim of a violent crime, first, make sure you are in a safe place and with people you trust and second, contact the country director or the Peace Corps medical officer. Immediate reporting is important to the preservation of evidence and the chances of apprehending the suspect. Country directors and medical officers are required to report all violent crimes to the Inspector General and the RSO. This information is protected from unauthorized further disclosure by the Privacy Act. Reporting the crime also helps prevent your further victimization and protects your fellow Volunteers.

In conjunction with the RSO, the OIG does a preliminary investigation of all violent crimes against Volunteers regardless of whether the crime has been reported to local authorities or of the decision you may ultimately make to prosecute. If you are a victim of a crime, our staff will work with you through final disposition of the case. OIG staff is available 24 hours-a-day, 7 days-a-week. We may be contacted through our 24-hour violent crime hotline via telephone at 202.692.2911, or by e-mail at violentcrimehotline@peacecorps.gov.

When it comes to your safety and security in the Peace Corps, you have to be willing to adapt your behavior and lifestyle to minimize the potential for being a target of crime. As with anywhere in the world, crime does exist in El Salvador. You can reduce your risk of becoming a target for crime by avoiding situations that make you feel uncomfortable and by taking advance precautions. Crime at the village or town level is less frequent than in the large cities, where people know each other and generally will not steal from their neighbors. Tourist attractions, especially in large towns, are the favorite work sites for pickpockets.

You must be prepared to take on a large responsibility for your own safety. Only you can make yourself less of a target, ensure that your house is secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to El Salvador, do what you would do if you moved to a large city in the United States: be cautious, check things out, ask questions, learn about your neighborhood, know where the more risky locations are, use common sense, and be aware. You can reduce your vulnerability to crime by integrating into your community, learning the local language, acting responsibly, and abiding by Peace Corps policies and procedures. Serving safely and effectively in El Salvador may require that you accept some restrictions to your current lifestyle.

Volunteers attract a lot of attention in large cities and their sites, they but receive far more negative attention in highly populated centers where they are anonymous. In smaller towns, “family,” friends, and colleagues look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to such negative and unwanted attention. Other methods have helped Volunteers avoid becoming targets of unwanted attention and crime. Keep your money out of sight—use an undergarment money pouch, such as the kind that hangs around your neck and stays hidden under your shirt or inside your coat. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs. You should always walk at night with a companion.

In El Salvador, Volunteers may be impacted by incidents of theft due to the current economic situation and impacts of the post-conflict era. As a Volunteer, you have to be willing to forego certain freedoms that you may take for granted; freedoms like going to a deserted beach or forest, going out alone at night, or walking alone on some roads. You must take precautions that you may not be accustomed to taking in your hometown or city. And even if you take those precautions, you may be a victim simply because somebody wants something and they think they can get it from you—items such as money, electronics, jewelry, a bicycle, camera, appliance, or clothes.

People react differently to the threat of crime. The challenge of each Volunteer is to identify what threats are real and then to develop strategies to minimize the risks so that they can concentrate on the work that they came to do. The Peace Corps will help you understand the risks and how to live safely, but personal safety is the responsibility of each individual. Building your own safety net and habits is an important part of integrating into any culture. Choosing the right friends, dressing appropriately, concealing valuable items, living in a safe neighborhood where you interact with your neighbors, staying away from isolated places, using safe transportation at night, and locking your doors are all precautions that you must take to enhance your personal safety as a Volunteer.

It is possible that during your Peace Corps service you may become a victim of physical or sexual assault. It happens in the Peace Corps world, as it does in the United States. More than 40 years of Peace Corps experience worldwide indicates that, just as in the United States, you can help avoid or reduce some of the risk by being sensitive to your surroundings, culture, and environment; by modifying some habits or behavior; and by using common sense. You will receive a thorough briefing on how to minimize risk in El Salvador. Should you become a victim of violence, the medical office is there to help you, and the medical unit will keep your information confidential. Should you become a victim of assault or other violence, it is imperative that you inform the Peace Corps medical office and receive appropriate care, including care for your emotional well-being.

Crime is a problem throughout the world, and it is a concern in El Salvador. Peace Corps/El Salvador has also taken steps to help Volunteers lessen their risk of being victims of crime and has put in place safety criteria for site placement and housing, made programming changes, and continuously improved safety and security training during pre-service training and throughout the two-year period of Volunteer service. Peace Corps/El Salvador has also increased Volunteer preparedness as Volunteers pass their awareness, knowledge, and history on to succeeding groups of Volunteers.

The Peace Corps’ approach to safety is a five-pronged plan to help you stay safe during your two-year service and includes the following: information sharing; Volunteer training; site selection criteria; a detailed emergency action plan; and protocols for addressing safety and security incidents. El Salvador’s in-country safety program is outlined below.

Information sharing can take many forms, but essentially this means that the Peace Corps/El Salvador office will keep Volunteers informed of any issues that may impact Volunteer safety. Regular updates will be offered in Volunteer newsletters and in memoranda from the country director. Similarly, Peace Corps/El Salvador also asks that Volunteers keep the staff informed of any changes or developments in the safety and security climate of their site or region. In the event of a critical situation or emergency, Volunteers will be contacted through the emergency communication network.

Volunteer training will include sessions to prepare you for specific safety and security issues in El Salvador. This training will prepare you to adopt a culturally appropriate lifestyle and to exercise judgment that promotes safety and reduces risk in your home, at work, and while traveling. Safety training is offered throughout your two-year service and is integrated into the language, cross-cultural, health, and other components of training.

Certain site selection criteria are used to determine safe housing for Volunteers before their arrival. Peace Corps staff works closely with host communities and counterpart agencies to help prepare them for the Volunteer’s arrival and to establish expectations of their respective role in supporting the Volunteer. Each site is inspected before the Volunteer’s arrival to ensure assignment to an appropriate, safe, and secure housing and work site. Site selection criteria are based, in part, on any relevant site history; access to medical, banking, postal, and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements; and other support needs.

You will also learn about the country’s detailed emergency action plan, which exists in case of civil or political unrest or a natural disaster. When you arrive at your site, you will complete and submit a site locator form with your address, contact information, and a map to your house. If there is a security threat, Volunteers in El Salvador will gather at predetermined locations until the situation resolves itself or the Peace Corps decides to evacuate.

Finally, in order to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to the Peace Corps medical officer. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner. In addition to responding to the needs of the Volunteer, the Peace Corps collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.